Social Anxiety

People suffering from social anxiety disorder experience intense, irrational, and uncontrollable anxiety in a wide variety of social situations. They fear being negatively judged, especially in public, which (in their minds) could lead to rejection, embarrassment, humiliation, and exposure to criticism or ridicule.

Social anxiety disorder sufferers know these fears are illogical and out of proportion. But their anxiety functions more like an instinct or reflex than a reasoned response, and that makes it impossible to ignore or suppress.

In addition to their anxiety people with social anxiety disorder have significant self-esteem issues, which leads them to put too much emphasis on the opinions of others. They want desperately to be liked and accepted, but deep down they don’t see themselves as worthy.

Among the general public, social anxiety disorder remains largely unknown. But the statistics reveal its significant impact:

• In the United States, 15 million adults (approximately seven percent of the population) will suffer from anxiety disorder in any given year.
• 30 percent of men and women diagnosed with social anxiety disorder experience severe impairment and anxiety.
• The lifetime incidence of social anxiety disorder among adults is 12.1 percent.
• Among the 13-18 age group, the lifetime incidence of social anxiety disorder is 5.5 percent.
• 25 percent of adolescents with social anxiety experience severe impairment and anxiety.
• The median age of onset for social anxiety disorder is 13, and 75 percent of sufferers develop the condition between the ages of eight and 15.
• Between 69 and 81 percent of social anxiety sufferers have co-occurring mental and behavioral health conditions, such as depression, generalized anxiety, panic disorder, and substance use disorders.
• Social anxiety disorder is the second most common form of anxiety disorder, trailing only specific phobias.

Social anxiety disorder causes an extreme form of self-consciousness. Social anxiety sufferers are so preoccupied with their fears and worst-case scenario imaginings that they are unable to relax or adopt a more rational perspective, and their thinking processes create an anticipatory anxiety that is as strong as their actual anxiety in social situations.

As a protective mechanism, they develop strategies to avoid social contact and public speaking, and when they are forced to converse or express themselves they attempt to keep their exposures as brief as possible. In reality, social anxiety sufferers crave human connection and often fantasize about living differently, but their fear of humiliation and rejection is so strong it seems impossible to subdue.

While they fear the harsh opinions of others, in reality people with social anxiety disorder are their own worst critics. Both during and after their social interactions they are constantly evaluating their own performance, and their judgements are almost always negative and dominated by second-guessing and self-admonishment.

Beyond their excessive and irrational fears, individuals with severe social anxiety experience a broad range of debilitating anxiety symptoms. These physiological reactions to self-generated stress include:

• Sweating
• Blushing
• Trembling
• Shivering and feeling cold
• Dry mouth
• Racing heartbeat
• Stomach cramps or nausea
• Dizziness or lightheadedness
• Respiratory difficulties
• Muscle tension accompanied by physical pain (usually in the shoulders, face, or neck)
• Talking too fast, stumbling over words
• Brain fog (inability to process information or think of anything to say)

What people with social anxiety disorder experience is similar to the classic “fight-or-flight” response, which manifests as a reaction to perceived danger.

Virtually any social situation or communication-related activity can trigger intense anxiety symptoms, extreme self-consciousness, and psychological discomfort in social anxiety sufferers. Some of the more common triggers include:

• Meeting new people
• Interactions with distant family members
• Parties or other large gatherings
• Work or school situations where the person with social anxiety disorder must defend themselves or their ideas
• Encounters with authority figures (teachers, doctors, subject area experts, famous people, etc.)
• Answering the phone or making calls
• Social exchanges with children or elderly people
• Interactions with extreme extroverts
• Attempts to chat by strangers in lines at stores, banks, movie theaters, etc.
• Dating, or communications with people who generate romantic interest
• Needing to ask for attention or assistance from retail employees or public servants

These social situations can evoke anticipatory anxiety before the fact, uncomfortable anxiety symptoms during the interaction, and extreme self-consciousness afterwards, as the individual with social anxiety disorder replays the encounter over and over in their minds while severely critiquing their own performance.

Sadly, the fears and anxieties of individuals with social anxiety disorder often become a self-fulfilling prophecy. Their anxiety can be so overwhelming that it dramatically affects their communication or social performance, leading others to reject them, avoid them, or abandon them, just as they feared all along.

Needless to say, when a stressful social encounter confirms a social anxiety sufferer’s worst fears it can leave emotional scars and painful memories that reinforce the hold social anxiety has over their lives.

Rather than having one simple cause, social anxiety disorder likely emerges from the interaction of genetic factors, environmental influences, and personality characteristics.

While people with social anxiety disorder often have trouble discussing their lives and their symptoms with physicians or mental health professionals (they are authority figures and often intimidating to social anxiety sufferers), without such a dialogue the disorder cannot be diagnosed.

Social anxiety is identified through its symptoms, plus a thorough physical examination that rules out any other causes or contributing factors. Social anxiety disorder can sometimes be confused with panic disorder, but that condition causes an intense fear of fainting, passing out or even dying, and those types of fears are not associated with social anxiety disorder.

The American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM-5) lists multiple criteria for diagnosing social anxiety disorder. They include:

• Persistent fear of being judged, embarrassed, or humiliated in specific social situations
• Avoidance of situations known to provoke anxiety, or experiencing unrelenting anxiety during such encounters
• Fears that are disproportionate to any realistically possible consequence
• Anxiety so strong it inhibits functioning and interferes with daily living
• No underlying medical conditions that could cause anxiety symptoms to appear
• Symptoms of social anxiety that have endured for six months or longer

While many people experiencing the symptoms of mental illness are worried or distraught after receiving a diagnosis, with social anxiety disorder the usual reaction is relief. Having a label to put on their symptoms lets them know they aren’t alone in the world, and it reassures them by confirming their problems aren’t the result of weakness, inferiority, or lack of willpower.

Like any other mental health disorder, social anxiety disorder can be successfully treated, and if the services offered are properly targeted they can be highly effective.

The long-term prognosis for people with social anxiety disorder is excellent, especially if they can find help from therapists who have experience working with socially anxious patients, or in residential treatment facilities that offer treatment plans specifically customized for social anxiety disorder. The latter can be especially important if co-occurring disorders are present that also need to be addressed.

Social anxiety disorder can be treated on an inpatient or outpatient basis, or a combination of both, and should include a combination of:

• Psychotherapy. Cognitive-behavioral therapy (CBT) is the preferred form of counseling for social anxiety sufferers, who need to reprogram their thinking patterns and change the behaviors that reinforce them. It is also essential that their recovery regimens include active behavioral therapy sessions in the support group format, where people with social anxiety disorder can share stories and experiences with others who’ve walked in their shoes.
• Medication. Drugs from the SSRI antidepressant category, specifically Paxil and Zoloft, are usually the first medications prescribed for people with severe social anxiety. Other options include anti-anxiety medications (primarily benzodiazepines) for short-term symptom relief and other categories of antidepressants if a co-occurring mood disorder has been diagnosed.
• Life skills training. People with social anxiety disorder lack social and communication skills, and practical strategies designed to help them overcome these limitations are vital to their ultimate recovery.
• Holistic health practices. Given their propensity to experience severe stress and anxiety, holistic anti-stress activities like meditation, yoga, massage therapy, acupuncture, music and art therapy, and martial arts practice can be supremely useful for social anxiety sufferers.

In their approach to healing and recovery, people with social anxiety disorder tend to be dedicated, diligent, attentive, and focused, and their cooperative attitude during therapy is a key factor in their advanced capacity for change and growth. As their self-confidence increases during treatment their social anxiety is gradually reduced to a more manageable level, where it no longer has the ability to completely control their lives.